| NPI | 1194258442 |
|---|---|
| Former Name | STACY KATHLENA KELSO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MI L534315) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |